Health inspection·July 3, 2023

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to trim toenails for 1 of 6 residents (R4) reviewed for Activities of Daily Living (ADLs) assistance in the sample of 9. Residents Affected - Few Findings include: R4's admission Record, print date of 6/29/23, documents that R4 was admitted on [DATE] and has diagnoses of Parkinson's Disease and Dementia. R4's Minimum Data Set, dated [DATE], documents that R4 is severely cognitively impaired, requires supervision and set up help for bed mobility, transfer, ambulation, eating, extensive assistance of 1 staff member for dressing, toileting, hygiene, dependent of 1 staff member for bathing and is frequently incontinent of bowel and bladder. R4's Care Plan, dated 9/28/22, documents, Self-Care Deficit As Evidenced by: Needs extensive assistance with ADLs (Activities of daily Living) Related to poor balance, weakness, limited mobility, impaired cognition, tremors, Parkinson's Disease. Personal Hygiene - One-person physical assist required. BATHING/SHOWERING: Check nail length and trim and clean on bath day and as necessary. Report any changes to the nurse. R4's Shower Sheets, dated 5/17/23 - 6/23/23, were reviewed. On 6/20/23 and 6/23/23 it was noted that R4's toenails needed to be put on the list for podiatry to see. On 6/29/23 at 9:00 AM, V1, Administrator, stated, I think I know what this is about. Over the weekend our Corporate Nurse (V9) called, apparently, she and (R4's) son (V5) are friends and (V5) called her and said that he was a little disappointed in how (R4's) toenails looked. We looked into it and actually (V4 Certified Nurse's Aide, CNA) marked on her shower sheet that R4 needed to be put on the list for podiatry to see. On 6/29/23 at 9:18 AM, V4 stated, I noticed her toenails 2 showers ago and I circled on the sheet that she needed to be put on the list for podiatry to see. Her nails were thick and growing sideways over the other nail. They were extremely long. Her nails were weird they grew out then sideways. I was not comfortable cutting them myself. On 6/29/23 at 9:28 AM, V5, R4's son, stated, (R4's) toenails were very long and thick. They were about an inch long and growing sideways into her other toes. On 6/29/23 at 10:30 AM, V10, Licensed Practical Nurse (LPN), stated, The aides would help her (R4) Page 1 of 2 145783 145783 07/03/2023 Sunrise Skilled Nur & Rehab 333 South Wrightsman Street Virden, IL 62690

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few with incontinent care and bathing. I would do skin checks on her to check her heels to see if they were boggy or breaking down. I really don't remember what her toenails looked like. The CNAs will cut toenails as long as they are not diabetic which (R4) was not. On 6/29/23 at 11:28 AM, V11, Social Service Director, stated, Anytime someone wants to be put on the podiatry list, I get a signed consent form and then send it to the podiatry office. (R4) had never seen the podiatrist before and I did not have a consent for her. Nobody told me that she needed her toenails clipped until after the fact that she was in the hospital and now she is not coming back here so I can't do anything about it. The podiatrist was just here on 6/20/23. On 6/29/23 at 11:00 AM, V3, Assistant Director of Nurses, stated, On Sunday (6/25/23) I got a call from (V9), and she told me that (V5) had called her and complained about (R4's) toenails. She told me she wanted a toenail check done on the whole building and that is what we are working on now. The CNAs can cut toenails if they are not a diabetic. We do have a podiatrist that will come and the residents that sign up for that service get seen about every 60 - 90 days. On 6/29/23 at 2:00 PM, V8, CNA, stated, I will cut residents toenails myself if they are not diabetic. If diabetic I let the nurse know so they can get on the podiatry list. On 6/29/23 at 2:20 PM, V7, CNA, stated, I will write it on the shower sheet if a resident needs their toenails cut and tell the nurse. I will cut them if they aren't diabetic. The Nail Care (Fingers & Toes) policy, dated 9/15/2019, documents, Policy: Nail care will be provided for all residents in order to provide cleanliness, prevent spread of infection, for comfort, and to prevent skin problems. Residents' nails will be kept neat and clean. Responsibility: It is the responsibility of all Nursing staff to ensure that nail care is provided to all residents as needed. It is the responsibility of the Podiatrist or charge Nurse to provide toenail care for diabetic residents. 145783 Page 2 of 2